Karen, “parent of kid with T1” from North
Carolina, writes: Hi Wil, my 11-year-old son was diagnosed
with T1 diabetes about a little over a month ago. I’ve been frustrated with
well-meaning people who hear the news and try to reassure my son by saying that
he can just start eating better and then he can stop taking insulin. It’s like
hearing someone tell your kid not to worry about learning to swim because with
just a little practice he can learn how to breathe underwater: Thanks for the
advice that will kill my kid if he follows it! Anyway, I’m somewhat fruitlessly
trying to explain to people what the T1/T2 differences are, but I keep running
into the same question: If the problem with T2 is not insulin production
but insulin sensitivity, why do people with T2 sometimes need to inject/pump
insulin? I’ve asked several people, including two super smart dudes with
T2, and no one really seems to know anything less vague than “because the body
can’t regulate blood sugar on its own anymore.” Can you help me out?

Wil@Ask D’Mine answers: First, to your son, welcome to the
family. Second, to you, I’m so glad you found us. Third, you bet I can help you
out! And more. I think I can explain the “why do some T2s need insulin”
question so that you can understand it, and then I’m going to raise the bar and
try to come up with an elevator speech
version you can deploy in the field to help you with those well-meaning (but
ignorant) people you keep encountering.

Why? Because I’m
more worried about your blood pressure than your kid’s diabetes.

But for our new
Healthline readers (Hello, and thanks for
dropping by!) let me start by recapping the facts about the two major classifications
of diabetes: Type 1 and Type 2. These are commonly abbreviated either
T1 and T2, or T1D and T2D by the community. [There’s also a pregnancy version called Gestational Diabetes, but that’s too far off topic for
today.]

Sometimes you’ll
also hear us talk about type 3, which for years has been slang for someone who loves a T1 or
T2. We use this term to acknowledge the fact that diabetes doesn’t just affect
the individual who has it, but also the entire family. A type 3 could be
a spouse, sibling, parent, child, grandparent, aunt or uncle, niece or nephew,
cousin, cohabitating spousal equivalent, same-sex partner, in-law, step-person,
adopted family member, honorary family member, roommate, or even a family pet. Yep,
basically anyone in the family tree, or in the person with diabetes’ domicile
or ecosystem. Trust me on this, if you live in close contact with a person with
diabetes, that person’s diabetes will have an impact on your life!

Of course, the term Type 3 Diabetes has started becoming more commonly aligned with the Diabetes-Alzheimer's Disease connection, so many have started referring to spouses, D-parents and other caregivers by the umbrella term of "Type Awesome."

Since parents like yourself are often called D-moms or D-dads, here are a couple choices you might consider printing on your new D-businesses cards:

Karen, Type Awesome …or… Karen, D-Mom

At your son’s
diagnosis, did the doctors remember to tell you how much fun this whole
diabetes thing was going to be?

Oh, and while we’re
on the subject of labels, as both you and many of our readers are new to the
diabetes space, I should talk about your son’s D-businesses card, too. I could
fill a whole column talking about this, and maybe I will in the future, but quickly,
some people with diabetes feel the term “diabetic” is somehow vulgar and they’ve
been advocating for “person with diabetes” (or PWD for short) instead. They’ve made enough noise
over the last few years that we D-journalists have pretty much standardized on that term.

Whew! So much for the linguistics lesson. Now, let’s dig into what
you really wanted to know in the first place: The pathophysiology of the
various flavors of diabetes. Type 1, arguably the hardest type to live with, is
the easiest type to explain. It’s an autoimmune disease in which the immune
system freaks out and kills the insulin-producing beta cells in the pancreas.
The immune system, working right or short-circuited, is an amazing weapon to
behold. It’s very good at its job. In short order, people with type 1 have no
insulin left in their bodies, and simply put, without insulin death follows
closely. Luckily for all of us with type 1 today, for almost a hundred years we’ve been able to medically replace the
insulin our bodies lack by taking daily injections of insulin.

Type 2, on the
other hand, ain’t so simple. A T2’s body produces insulin, but cannot use it well. The insulin sensitivity you talked about is actually a form of insulin resistance. A T2’s body just isn't able to properly process the insulin present. This allows the blood sugar level to begin to climb, and that in turn triggers
signals for yet more insulin. Most early-stage type 2s are literally flooded
with insulin. For a time, the body can over-produce insulin in large enough
quantities to overwhelm the insulin resistance, but like a water pump in a well
left on night and day with no rest, the pancreas eventually burns out and
insulin production sputters to a stop. At this point, from a practical strandpoint,
there’s no real difference between a T1 and a T2 except for the path they followed
to get to the same point.

In type 2s, this
insulin production burnout is a slow-motion process that can take decades to
complete. Prior to total pancreatic burnout there are any number of therapies
that can help -- all of those oral drugs you hear about -- but any type 2 who lives with the disease long enough will
become dependent on insulin eventually. In some cases, doctors and patients hold out till
the last second. A more enlightened approach is to add some supplemental
insulin earlier on in the process to take a load off the poor pancreas and put
off the total burnout thing. So there you go: Type 2s need insulin when their
disease gets to the point where their bodies can no longer produce enough
insulin to keep the blood sugar in control.

Now, to that elevator
speech I promised you. You know, now that I think about it—and I know I’ll get
some heat about this—I think all of us T1s, T2s, and T3s should give up on
trying to educate the general public. It’s futile, and our energy is better
spent elsewhere. Let’s face the facts, Folks: Even many people with diabetes
don’t understand the differences between the types, so why should we expect the
general public to be able to understand? In general, people only have the time
(and the need) to understand the diseases that directly affect them or their
loved ones. So Karen, instead of trying to educate the masses one well-intended
ignoramus at a time, I think you just need a quick way to get people off your
back. For that, I recommend:

“Oh, thank you for that suggestion, but my
son has the other kind of diabetes. No matter what he eats, his body
doesn’t produce any insulin at all, and without insulin injections he’ll die.”

After all,
trying to educate everyone on the differences between T1 and T2 diabetes is like trying to learn to breathe underwater.

Disclaimer: This is not a medical
advice column. We are PWDs freely and openly sharing the wisdom of our
collected experiences — our been-there-done-that knowledge from the
trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear
trees. Bottom line: we are only a small part of your total
prescription. You still need the professional advice, treatment, and
care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more
details click
here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community.
The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines.
For more information about Healthline's partnership with Diabetes Mine, please click here.

Related posts

As it's Back to School season, we thought it would be valuable to hear some wisdom from a school nurse, on the front lines of helping take care of kids and teens with diabetes during school days. It's a tough job. So today we welcome fellow T1D Ca...

Hey Diabetes Community! Back-to-School time is right around the corner once again, but don't worry -- the College Diabetes Network has your back!Not quite a decade old, this Boston-based organization has been growing by leaps and bounds, and very ...

Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by Wil Dubois, a veteran type 1 in New Mexico who is a diabetes author with many years of clinical experience under his b...

Hey, All -- Got questions about life with diabetes? Then you've come to the right place! That would be our weekly diabetes advice column, Ask D'Mine, hosted by longtime type 1 and diabetes author Wil Dubois in New Mexico, who spent many years ...

Once upon a time, good luck landing a lot of different jobs if you were a known type 1 diabetic. Today, things are looking a whole lot brighter. Wil reports... Not that long ago there was a long list of career opportunities that were, simply...